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Prevalence of statin intolerance: a meta-analysis.

Bytyçi, I, Penson, PE, Mikhailidis, DP, Wong, ND, Hernandez, AV, Sahebkar, A, Thompson, PD, Mazidi, M, Rysz, J, Pella, D, Reiner, Ž, Toth, PP, Banach, M, LBPMC, and ILEP, (2022) Prevalence of statin intolerance: a meta-analysis. European Heart Journal. pp. 1-16. ISSN 0195-668X

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AIMS: Statin intolerance (SI) represents a significant public health problem for which precise estimates of prevalence are needed. Statin intolerance remains an important clinical challenge, and it is associated with an increased risk of cardiovascular events. This meta-analysis estimates the overall prevalence of SI, the prevalence according to different diagnostic criteria and in different disease settings, and identifies possible risk factors/conditions that might increase the risk of SI. METHODS AND RESULTS: We searched several databases up to 31 May 2021, for studies that reported the prevalence of SI. The primary endpoint was overall prevalence and prevalence according to a range of diagnostic criteria [National Lipid Association (NLA), International Lipid Expert Panel (ILEP), and European Atherosclerosis Society (EAS)] and in different disease settings. The secondary endpoint was to identify possible risk factors for SI. A random-effects model was applied to estimate the overall pooled prevalence. A total of 176 studies [112 randomized controlled trials (RCTs); 64 cohort studies] with 4 143 517 patients were ultimately included in the analysis. The overall prevalence of SI was 9.1% (95% confidence interval 8.0-10%). The prevalence was similar when defined using NLA, ILEP, and EAS criteria [7.0% (6.0-8.0%), 6.7% (5.0-8.0%), 5.9% (4.0-7.0%), respectively]. The prevalence of SI in RCTs was significantly lower compared with cohort studies [4.9% (4.0-6.0%) vs. 17% (14-19%)]. The prevalence of SI in studies including both primary and secondary prevention patients was much higher than when primary or secondary prevention patients were analysed separately [18% (14-21%), 8.2% (6.0-10%), 9.1% (6.0-11%), respectively]. Statin lipid solubility did not affect the prevalence of SI [4.0% (2.0-5.0%) vs. 5.0% (4.0-6.0%)]. Age [odds ratio (OR) 1.33, P = 0.04], female gender (OR 1.47, P = 0.007), Asian and Black race (P < 0.05 for both), obesity (OR 1.30, P = 0.02), diabetes mellitus (OR 1.26, P = 0.02), hypothyroidism (OR 1.37, P = 0.01), chronic liver, and renal failure (P < 0.05 for both) were significantly associated with SI in the meta-regression model. Antiarrhythmic agents, calcium channel blockers, alcohol use, and increased statin dose were also associated with a higher risk of SI. CONCLUSION: Based on the present analysis of >4 million patients, the prevalence of SI is low when diagnosed according to international definitions. These results support the concept that the prevalence of complete SI might often be overestimated and highlight the need for the careful assessment of patients with potential symptoms related to SI.

Item Type: Article
Additional Information: This is a pre-copyedited, author-produced version of an article accepted for publication in European Heart Journal following peer review. The version of record: Ibadete Bytyçi, Peter E. Penson, Dimitri P. Mikhailidis, Nathan D. Wong, Adrian V. Hernandez, Amirhossein Sahebkar, Paul D. Thompson, Mohsen Mazidi, Jacek Rysz, Daniel Pella, Željko Reiner, Peter P. Toth, Maciej Banach, on behalf of the Lipid and Blood Pressure Meta-Analysis Collaboration (LBPMC) Group and the International Lipid Expert Panel (ILEP), Prevalence of statin intolerance: a meta-analysis, European Heart Journal, 2022: is available online at: https://doi.org/10.1093/eurheartj/ehac015
Uncontrolled Keywords: 1102 Cardiorespiratory Medicine and Haematology, 1103 Clinical Sciences
Subjects: R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
R Medicine > RS Pharmacy and materia medica
Divisions: Pharmacy & Biomolecular Sciences
Publisher: Oxford University Press
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Date Deposited: 28 Feb 2022 11:31
Last Modified: 16 Feb 2023 00:50
DOI or ID number: 10.1093/eurheartj/ehac015
URI: https://researchonline.ljmu.ac.uk/id/eprint/16420
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